Healthcare Provider Details

I. General information

NPI: 1215392279
Provider Name (Legal Business Name): LORDS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E COMMERCIAL BLVD
OAKLAND PARK FL
33334-1621
US

IV. Provider business mailing address

33 E COMMERCIAL BLVD
OAKLAND PARK FL
33334-1621
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-3685
  • Fax: 954-771-8561
Mailing address:
  • Phone: 954-771-3685
  • Fax: 954-771-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6493
License Number StateFL

VIII. Authorized Official

Name: DR. JEFF A MIDDLETON
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 954-771-3685